Stress is hard on your body-and can aggravate diabetes. Here's how to take control.

Researchers have linked dozens of physical symptoms to stress overload, from fatigue to weight gain. Add another symptom to that list: the risk for high blood sugar.

What's more, depression, which can be a major response to stress, is considered a primary risk factor for cardiovascular disease. This can be a particular problem for people with high blood sugar, who are already at higher-than-normal risk of heart disease. Stress raises blood pressure, which damages the linings of blood vessels. At the same time, substances that are released during times of stress, such as fatty acids, are trapped in these damaged areas. This leads to the development of plaques, fatty deposits that can block blood-flow, increase the risk of clots, and possibly lead to heart attacks.

It doesn't have to be this way. Stress isn't the deadline, the traffic jam, or the surly teenager-it's the way you react to things. That's why one woman who sees a long line at the supermarket may feel her temper rising out of control, while another contentedly browses through a trashy tabloid.

No matter how much stress you experience, you can do something about it. Once you identify the causes of stresses in your life and recognize the danger signs, you can take steps to reduce them. You'll find dozens of tips in the next chapter. In the meantime, here's what we know about the effect of stress on blood sugar.

Stress: Not Just "In Your Head"

While we tend to view stress as toxic to our minds, we generally don't consider its potentially harmful effects on the body. But the physical effects of stress are profound.

During times of stress, your body gears up to take action. This "gearing up" is called the fight-or-flight response, and it's what causes your heart to beat faster, your breath to quicken, and your stomach to knot. It also causes the skyrocketing of many hormones-a signal to flood your cells with the energy they need, in the form of blood sugar and fat, to deal with the threat.

Stress plays a direct role in how your body responds to the hormones that raise blood sugar levels. "Under stress, your body goes into fight-or-flight mode, raising blood sugar levels to prepare you for action," says Richard Surwit, PhD, author of The Mind-Body Diabetes Revolution and chief of medical psychology at Duke University in Durham, NC. If your cells are insulin resistant, the sugar builds up in your blood, with nowhere to go.

We have no shortage of short-term stress in our lives. We may get stuck in a traffic jam, wrangle with a worker at the department of motor vehicles, or put up with in-laws for the holidays. But much of our stress is chronic in nature-the result of working long hours at a demanding job, caring for an aging parent, or even recovering from surgery.

The bottom line? Our stress hormones, which were designed to deal with short-term dangers such as fleeing predators, are turned on for long periods of time, even though we're neither fighting nor fleeing. What we're doing is stewing, which can cause chronically high levels of blood sugar.

Relax To Rein In Blood Sugar

The good news is that controlling stress with relaxation therapy seems to help control high blood sugar. What's more, simple relaxation exercises and other stress-management techniques can help you gain more control over blood sugar levels, according to a study conducted at Duke University.

More than 100 people with high blood sugar took five diabetes-education classes either with or without stress-management training. After a year, more than half of the stress-relief group improved blood sugar significantly, enough to lower their risk for the worst complications, such as heart disease, kidney failure, nerve damage, and vision problems.

Study participants soothed their stress with a variety of techniques: progressive muscle relaxation, deep breathing, and positive mental imagery as well as by stopping high-tension thoughts. (You can buy a compact disk and manual of the relaxation training program used in the study at richardsurwit.com.)

There are many, many ways to teach yourself to handle stress better-and you can learn. It just comes down to making the commitment and taking the time to learn one (or more). One way to start on the road to low-stress living is to seek out a local stress-relief class, which are offered by many hospitals, YMCAs, and adult-education programs.

One thing, though: Tell your doctor you're starting a stress-reduction program. If you take medication, he may want to adjust your dose, so you don't end up with dangerously low blood sugar levels.

Step Off The Gas Too

Inserting little pockets of rest time into your life is a key aspect of reducing the effects of stress on your blood sugar levels and your health in general. They don't have to be long, but they should be frequent, because rest is essential for health and psychological and spiritual well-being.

"Rest is a natural and necessary part of life and of work," says Stephan Rechtschaffen, MD, cofounder of the Omega Institute for Holistic Studies in Rhinebeck, NY. He points out that the heart beats every second. "We might say that it works all the time. But in fact, it contract for one-tenth of a second and then rests for nine-tenths of a second."

It's easy to see that if the heart kept contracting without resting, it wouldn't function. Like our hearts, we, too, need regular rest breaks. "We need to step off the gas," says Wayne Muller, an ordained minister and psychotherapist in Mill Valley, CA, and author of Sabbath: Restoring the Sacred Rhythm of Rest. "Life works in rhythm-the seas, the tides, the body, everything. If we're only on one track-producing and working, without time for reflection and regathering-we're doing harm."

Don't feel guilty about spending some time relaxing when you have a lot to do, because a change of pace can make you more productive. "If you leave a problem for a while, and do something else, your mind will work on it in the background," says David Neubauer, MD, associate director of Johns Hopkins Sleep Disorders Center in Baltimore.

Take Control: Make Time For Life

No mater how busy you are, you can (and should) find ways to rest, relax, and enjoy your life. Start you day with yoga, meditation, or a walk. Reserve some hours each week to spend with your spouse or a close fiend, where you enjoy a special meal and share an activity. Above all, take back Sundays as a day of rest for family, leisure, and worship. Don't spend the day mowing the lawn, grocery shopping, or catching up on office work.

Is Diabetes Stressing You Out?

Having diabetes is in itself a source of stress-one that's unlikely to go away. Still, there's plenty you can do to reduce the stress of living with this condition.

First, seek out a diabetes support group, which can lighten the burden. It can help immensely to know that others are in the same boat with you-and that they understand. The people in these groups can also give you tips on how they cope with stress.

Confronting diabetes-related issues head-on can help too. Ask yourself what aspects of living with diabetes stress you the most. Is it taking your medication? Checking your blood sugar regularly? Eating the way you'd like to? Exercising?

For help in dealing with any of these issues, you might go to a member of your diabetes team or even a counselor. Talking about the issues you face as a person with diabetes can help you come to grips with these challenges and learn new and better ways of coping or changing your behavior.

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